What happened in this clinical incident?

The ability to recognize and respond to the requirement of a critical deteriorating patient is a crucial professional skill. An 81 years old patient A presented her symptoms to the General Practitioner (GP) on 5^th January 2013. Patient A presented severe deteriorating signs and symptoms that included; breathlessness, jugular venous pressure and her lungs had fine creeps.  The GP assessed the patient due to her unpredictable in symptoms he gave the patient an appointment after two days after prescribing her on some oral Lasix. The next day the patient attended a rural hospital with the similar symptoms as the oral Lasix did not make the significant effect. Patient A was then admitted to the local hospital as the symptoms continued to become more severe.  

Shifting of nurses occurred, the enrolled nurse notified RN John who took over on the progress of the patient.   After 3 hours of assessment, RN John called the clinical manager to arrange the medication for the patients. The nurse manager came and signed for medication for another patient, but RN John failed to address the issue of medicines concerning patient A. At around 2100 hours another registered nurse filled the Introduction Situation Background Recommendation Assessment (ISBRA).

The ISBRA form indicated that the health state of patient A was severely deteriorating with complex issues such as severe dehydration, abdominal pain and she was unable to take meals. DR. Aboud who was called on an emergency call arrived at the hospital at 2300 hours and treated Patient A with the cannula insertion due to the patient’s severe dehydration. Unfortunately, the patient died as the air evacuation team were assessing her while the arrangement to transfer her to a referral hospital were being made. Septicemia was then indicated as the primary cause of the patient’s death.

During hospitals emergencies, the healthcare professional has to act with imminent risk to save the patient’s fatal condition. According to the NMBA standards the nurse needed to take actions which would avail the functionality of the equipment and material used to treat and can extend the patient’s life. The priorities for the nurse was to plan for the care so as to meet for the therapeutic and care requirements for the 81 years old patient. Patient A required much attention and monitoring and the RN John was supposed to have collected the patient’s data and mapped the patient’s current care and the state of her condition. It is the responsibility of the midwife to keep in line with the patient’s requirement such as medications according to the NMBA standard 4 by informing the clinical manager and this integration articulate the healthcare services necessary to manage the patient’s care and self-care (Rutherford-Hemming, 2012). In considering the standard 5, understanding and asking the patient some relevant questions while reporting any of the complaints from the patient to the doctor or the managerial staff can help to improve the patient in a critical condition. It is the role of the nurse to determine and prepare earlier the essential materials for achieving the best assistance for the patient both qualitative and quantitative aspects.  In additional, collaboration with the GP and the other healthcare professional could help in collating and collecting the required information from the referral appointments and integrating the information into the review care plan (Grace, & DRN, Eds.2017).

What activities did the nurse or midwife need to complete in the immediate situation?

Registered nurse had to play role in reassessing the patients to take measures of the outcomes and offering the support by presenting the reports to the GP in accordance to the health care standard 5. It is the predominant role of the midwife or a nurse in technical dimension in managing and caring administration during the immediate situation. Systemization of the patient’s assistance according to the hospital’s rules standardizes the healthcare professional’s performance, and it makes it possible to identify immediate treatment of the problems that may put the patient at immediate risk of death due to the limitation of data and the correct diagnosis.  Some of the activities that the concerned nurse has to complete at the patient’s immediate conditions in accordance to the national safety and quality healthcare standards and NMBA is to ensure; keen observation, planning, explicit data gathering, evaluation, implementation proper care delivery and interaction between nursing staff, patients and family members and other healthcare professionals (Schultz, Koenig, Whiteside, Murray & National Standardized All-Hazard Disaster Core Competencies Task Force, 2012).

 The most important behaviors that could have brought a change in patient A situation is through quality and safety care and ensuring proper compliance with the clinical legislative requirement. RN John could have utilized the critical thinking of a registered nurse so as to maintain comprehensive, accurate and early documentation for the assessment, evaluations, actions, decision-making and planning. Earlier preparations could have improved and made a difference to the patient situation. Frequent communication with the patient is one of the most essential tools that a nurse can use to draw information and understand the patient’s condition better. The nature of communication varies from one nurse to another as in the case where rare communication between the RN John and the patient A made him not to make the immediate decisions that could have helped the patient improvement in regards to the NMBA standard 9 (Curtis et al., 2013). In such a situation where the origin of specific undeterminable symptoms makes it difficult to determine the disease like those of septicemia, there is a need for early the registered to have a clear description and informed consent of Patient A before undertaking any professional interaction or any therapeutic in management of the disease.  The nurse has the responsibility of frequent monitoring of the patient while noting every change of the symptoms. In such a case of patient A   an emergency assistance as part of quick response to the system. In conjunction to the NSQHS standard 2, the registered nurse needed to consult, use delegation and arrange for the early referrals for a similar professional relationship to improve the health outcomes of the patient (Purling & King, 2012). It is essential for the nurse to record any abnormal behavior of the patient and immediately report the issue to the doctor.  

What professional behaviours may have made a difference in this situation?

According to the Nursing and Midwifery Board and National Safety and Quality Health Services, registered nurses have to be sensitive to the ethical challenges and perform their moral duties to their best.  The essence of the code of conduct should be recognized and respected irrespective of who is receiving the healthcare, the nationality, religion, social-economic class, culture, age or gender (Maurer, & Smith, 2013). The National Safety Quality Services Association emphasizes on the need of a nurse to handle all the situations with a lot of seriousness, get more information from the informed consent before undertaking any therapeutic to the patient. (Stimpfel, Sloane & Aiken, 2012).

As a nurse, I have acquired knowledge and importance of nurse preparedness for emergency situations because the people that a nurse deals with have their health status compromised. I have to commit myself and participate actively at all times to maximize and improve quality care to the patient. An experienced and concern nurse has to be always ready in responding and recognizing deteriorating and acute clinical situations. As the RN I am always accountable for the safety and I have the capability to ensure self-management and responding according to the polices, regulations, guidelines and the legislative health standards for the quality care to the patient. Through the incident of this case study I have realized that the plan for the preparedness of an emergency situation should include the patient’s family and other healthy people in the community All nurses and the midwives should be taught how to handle physical, nutritional, mental, health care needs and to take care of the patient in severe health state (Bisholt, 2012). I learnt that nurses have a role in coordinating care and facilitating the communication between the patient and the families and among the healthcare staffs during a tragic situation (Melnyk, Gallagher?Ford, Long, & Fineout?Overholt, 2014).

Clear communication is a crucial tool in responding to the complicated situation, and it can be achieved through paper documentation, informal, electronic communication. All healthcare providers and nurses have to collaborate at all levels with other nurses on excellent progress during emergency preparedness. Nurses also should demonstrate the sense of volunteering to ensure the best outcomes from their performance (Hibbard, & Greene, 2013).

Reference

Bisholt, B. K. (2012). The learning process of recently graduated nurses in professional situations—experiences of an introduction program. Nurse education today, 32(3), 289-293.

Curtis, J. R., Back, A. L., Ford, D. W., Downey, L., Shannon, S. E., Doorenbos, A. Z., … & Arnold, R. W. (2013). Effect of communication skills training for residents and nurse practitioners on quality of communication with patients with serious illness: a randomized trial. Jama, 310(21), 2271-2281.

Grace, P. J., & DRN, P. (Eds.). (2017). Nursing ethics and professional responsibility in advanced practice. Jones & Bartlett Learning.

Hibbard, J. H., & Greene, J. (2013). What the evidence shows about patient activation: better health outcomes and care experiences; fewer data on costs. Health affairs, 32(2), 207-214.

Maurer, F. A., & Smith, C. M. (2013). Community/public health nursing practice: Health for families and populations. Elsevier Health Sciences.

Melnyk, B. M., Gallagher?Ford, L., Long, L. E., & Fineout?Overholt, E. (2014). The establishment of evidence?based practice competencies for practicing registered nurses and advanced practice nurses in real?world clinical settings: Proficiencies to improve healthcare quality, reliability, patient outcomes, and costs. Worldviews on Evidence?Based Nursing, 11(1), 5-15.

Purling, A., & King, L. (2012). A literature review: graduate nurses’ preparedness for recognising and responding to the deteriorating patient. Journal of Clinical Nursing, 21(23-24), 3451-3465.

Rutherford-Hemming, T. (2012). Simulation methodology in nursing education and adult learning theory. Adult Learning, 23(3), 129-137.

Schultz, C. H., Koenig, K. L., Whiteside, M., Murray, R., & National Standardized All-Hazard Disaster Core Competencies Task Force. (2012). Development of national standardized all-hazard disaster core competencies for acute care physicians, nurses, and EMS professionals. Annals of emergency medicine, 59(3), 196-208.

Stimpfel, A. W., Sloane, D. M., & Aiken, L. H. (2012). The longer the shifts for hospital nurses, the higher the levels of burnout and patient dissatisfaction. Health affairs, 31(11), 2501-2509.